Combined targeted therapy and immunotherapy in anaplastic thyroid carcinoma with distant metastasis: A case report

Th9 Cytokines Inhibit Proliferation, Promote Apoptosis, and Immune Escape in Thyroid Carcinoma Cells

To investigate the regulatory effects of T helper 9 (Th9) cytokines on the proliferation, apoptosis and immune escape of thyroid cancer cells. The survival rate of human thyroid cancer cell line TPC-1 after treatment with 0, 1, 2.5, 5, 10, 20 ng/ml IL-9 (or IL-21) was determined by CCK-8 method and suitable concentrations of IL-9 and IL-21 were screened out. The TPC-1 cells cultured in vitro were randomly grouped into control group, IL-9 group, IL-21 group and IL-9+IL-21 group. After treatment with IL-9 and IL-21 factors, the proliferation and apoptosis of TPC-1 cells in each group were detected by CCK-8 method and flow cytometry, respectively. The flow cytometry was applied to detect the proportion of Th9 and activated CD8+ T cells in human peripheral blood lymphocytes co-cultured with TPC-1 in each group. The expression of TPC-1 and IL-9R and IL-21R protein in each group and human peripheral blood lymphocytes. Compared with the control group, the cell viability PCNA and Bcl-2 protein expression in TPC-1 cells were lower in the IL-9 group, IL-21 group and IL-9+IL-21 group (P<0.05). The apoptosis rate, proportions of Th9 and activated CD8+ T cells, killing rate of human peripheral blood lymphocytes, the expression of Bax and caspase-3 proteins in TPC-1 cells, the expression of TPC-1 and human peripheral blood lymphocytes IL-9R and IL-21R proteins were all higher (P<0.05) in IL-9+IL-21 group compared with the IL-9 group and the IL-21 group. The cell viability, PCNA and Bcl-2 protein expression in TPC-1 cells in the IL-9+IL-21 group were all lower (P<0.05). Th9 cytokines can promote the differentiation of Th9 cells and CD8+ T cells, enhance their lethality, reduce the immune escape of thyroid cancer cells, and then inhibit their proliferation and promote their apoptosis.

Harnessing Immunity to Treat Advanced Thyroid Cancer

The incidence of thyroid cancer (TC) has increased over the past 30 years. Although differentiated thyroid cancer (DTC) has a good prognosis in most patients undergoing total thyroidectomy followed by radioiodine therapy (RAI), 5-10% of patients develop metastasis. Anaplastic thyroid cancer (ATC) has a low survival rate and few effective treatments have been available to date. Recently, tyrosine kinase inhibitors (TKIs) have been successfully applied to RAI-resistant or non-responsive TC to suppress the disease. However, TC eventually develops resistance to TKIs. Immunotherapy is a promising treatment for TC, the majority of which is considered an immune-hot malignancy. Immune suppression by TC cells and immune-suppressing cells, including tumor-associated macrophages, myeloid-derived suppressor cells, and regulatory T cells, is complex and dynamic. Negative immune checkpoints, cytokines, vascular endothelial growth factors (VEGF), and indoleamine 2,3-dioxygenase 1 (IDO1) suppress antitumor T cells. Basic and translational advances in immune checkpoint inhibitors (ICIs), molecule-targeted therapy, tumor-specific immunotherapy, and their combinations have enabled us to overcome immune suppression and activate antitumor immune cells. This review summarizes current findings regarding the immune microenvironment, immunosuppression, immunological targets, and immunotherapy for TC and highlights the potential efficacy of immunotherapy.